Healthcare Provider Details

I. General information

NPI: 1164889259
Provider Name (Legal Business Name): SHANNON RAYMOND RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4099 WILLIAM PENN HWY STE 202
MONROEVILLE PA
15146-2512
US

IV. Provider business mailing address

16 MARY LUE DR
PITTSBURGH PA
15223-1402
US

V. Phone/Fax

Practice location:
  • Phone: 412-372-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005735
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: